The impact of gender equity in agriculture on nutritional status, diets, and household food security: a mixed-methods systematic review

Abstract

Introduction: Undernutrition rates remain high in rural, low-income settings, where large, gender-based inequities persist. We hypothesised that increasing gender equity in agriculture could improve nutrition.

Methods: We conducted a systematic review to assess the associations between gender-based inequities (in income, land, livestock, and workloads) and nutrition, diets and food security outcomes in agricultural contexts of low-income and middle-income countries. Between 9 March and 7 August 2018, we searched 18 databases and 14 journals, and contacted 27 experts. We included quantitative and qualitative literature from agricultural contexts in low-income and middle-income countries, with no date restriction. Outcomes were women's and children's anthropometric status, dietary quality and household food security. We conducted meta-analyses using random-effects models.

Results: We identified 19 820 records, of which 34 studies (42 809 households) met the inclusion criteria. Most (22/25) quantitative studies had a high risk of bias, and qualitative evidence was of mixed quality. Income, land and livestock equity had heterogeneous associations with household food security and child anthropometric outcomes. Meta-analyses showed women's share of household income earned (0.32, 95% CI -4.22 to 4.86; six results) and women's share of land owned (2.72, 95% CI -0.52 to 5.96; three results) did not increase the percentage of household budget spent on food. Higher-quality studies showed more consistently positive associations between income equity and food security. Evidence is limited on other exposure-outcome pairings.

Conclusions: We find heterogeneous associations between gender equity and household-level food security. High-quality research is needed to establish the impact of gender equity on nutrition outcomes across contexts.

Prospero registration number: CRD42018093987.

Keywords: child health; maternal health; nutrition; systematic review.

Figure 1

Flowchart of the study selection process.

Figure 2

Forest plot of effects of women’s share of household income and women’s share of household land on percentage share of household expenditures spent on food. Weights are from random-effects models. Equity gap was calculated as the difference between perfect equity (0.5) and women’s proportion of income or land. I² for women’s share of income=91.7% unstandardised effects; 94.2% standardised effects. I² for women’s share of land=89.3% unstandardised effects; 97.8% standardised effects. *, rural Kerala; †, rural Maharashtra; ‡, rural Bihar; Std., standardised.